Biomarkers for prediction of mortality in left-sided infective endocarditis

被引:20
作者
Siciliano, Rinaldo F. [1 ,2 ]
Gualandro, Danielle M. [1 ,2 ,3 ,4 ]
Bittencourt, Marcio Sommer [5 ,6 ]
Paixao, Milena [1 ]
Marcondes-Braga, Fabiana [1 ]
Soeiro, Alexandre de Matos [1 ]
Strunz, Celia [1 ]
Pacanaro, Ana Paula [1 ]
Puelacher, Christian [2 ,3 ,4 ]
Tarasoutchi, Flavio [1 ]
Di Somma, Salvatore [2 ,7 ]
Caramelli, Bruno [1 ]
de Oliveira Junior, Mucio Tavares [1 ,3 ,4 ]
Mansur, Alfredo Jose [1 ]
Mueller, Christian [1 ,3 ,4 ]
Pereira Barretto, Antonio Carlos [1 ]
Varejao Strabelli, Tania Mara [1 ]
机构
[1] Univ Sao Paulo, Med Sch, Heart Inst InCor, Sao Paulo, Brazil
[2] GREAT Global Res Acute Condit Team Network, Sao Paulo, Brazil
[3] Univ Basel, Univ Hosp Basel, Cardiovasc Res Inst Basel CRIB, Basel, Switzerland
[4] Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland
[5] Univ Sao Paulo, Univ Hosp, Ctr Clin & Epidemiol Res, Sao Paulo, Brazil
[6] Hosp Israelita Albert Einstein, Sao Paulo, Brazil
[7] Univ Rome Sapienza, Dept Med Surg Sci & Translat Med, Rome, Italy
基金
巴西圣保罗研究基金会;
关键词
Infective endocarditis; Biomarkers; Prognosis; Mortality;
D O I
10.1016/j.ijid.2020.03.009
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: Evidence regarding biomarkers for risk prediction in patients with infective endocarditis (IE) is limited. We aimed to investigate the value of a panel of biomarkers for the prediction of in-hospital mortality in patients with IE. Methods: Between 2016 and 2018, consecutive IE patients admitted to the emergency department were prospectively included. Blood concentrations of nine biomarkers were measured at admission (D0) and on the seventh day (D7) of antibiotic therapy: C-reactive protein (CRP), sensitive troponin I (s-cTnI), procalcitonin, B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL6), tumor necrosis fator a (TNF-a), proadrenomedullin, alpha-1-acid glycoprotein, and galectin 3. The primary endpoint was in-hospital mortality. Results: Among 97 patients, 56% underwent cardiac surgery, and in-hospital mortality was 27%. At admission, six biomarkers were independent predictors of in-hospital mortality: s-cTnI (OR 3.4; 95%CI 1.8-6.4; P < 0.001), BNP (OR 2.7; 95%CI 1.4-5.1; P = 0.002), IL-6 (OR 2.06; 95%CI 1.3-3.7; P = 0.019), procalcitonin (OR 1.9; 95%CI 1.1-3.2; P = 0.018), TNF-alpha (OR 1.8; 95%CI 1.1-2.9; P = 0.019), and CRP (OR 1.8; 95%CI 1.0-3.3; P = 0.037). At admission, S-cTnI provided the highest accuracy for predicting mortality (area under the ROC curve: s-cTnI 0.812, BNP 0.727, IL-6 0.734, procalcitonin 0.684, TNF-alpha 0.675, CRP 0.670). After 7 days of antibiotic therapy, BNP and inflammatory biomarkers improved their performance (s-cTnI 0.814, BNP 0.823, IL-6 0.695, procalcitonin 0.802, TNF-alpha 0.554, CRP 0.759). Conclusion: S-cTnI concentration measured at admission had the highest accuracy for mortality prediction in patients with IE. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
引用
收藏
页码:25 / 30
页数:6
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